Provider Demographics
NPI:1265415491
Name:CHILDERS, HENRY E IV (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:E
Last Name:CHILDERS
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20930 DUPONT BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-1725
Mailing Address - Country:US
Mailing Address - Phone:302-258-8853
Mailing Address - Fax:302-253-8430
Practice Address - Street 1:20930 DUPONT BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-1725
Practice Address - Country:US
Practice Address - Phone:302-258-8853
Practice Address - Fax:302-253-8430
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0009809208G00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1659798353Medicare PIN
OHI02477Medicare UPIN
DE1265415491Medicare PIN